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Trinity Health · 16 hours ago

Director of Quality and Compliance

West Springfield, MA

Full-time

Onsite

Lead/Staff, Director/Executive

5+ years exp

Trinity Health is committed to providing high-quality care to seniors, and they are seeking a Director of Quality and Compliance to develop and monitor the Quality Improvement Plan for the PACE Organization. This role involves ensuring regulatory compliance, leading quality initiatives, and collaborating with various stakeholders to enhance service delivery and patient satisfaction.

DeliveryHealth Care

Responsibilities

Develop and implement the annual Quality Improvement (QI) Plan with the Medical Director

In conjunction with Medical Director, initiates, develops, and guides the implementation of the annual Quality Improvement plan. Compiles annual report and shares results with leadership, staff, contractors, administration, the Participant Advisory Committee (PAC), and Board of Directors

Assist with scheduling and coordination of the PACE Quality Committee in collaboration with Medical Director

Communicate the QI plan to members, staff, contractors, administration, Participant Advisory Committee (PAC), and the Board of Directors

Ensure compliance with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure annual review and approval of Compliance plan. Ensure that colleagues complete the activities and responsibilities identified in the Compliance program and those related to the HIPAA privacy rule

Manage preparation for CMS site visits, audits/inspections, and all subsequent follow up activities

Analyze risk management data and quality data in order to identify and control loss

Coordinates and maintains all activities pertaining to complaints, service delivery requests, and grievances/appeals, assures regulatory compliance and incident reporting including trend analysis for necessary action plans and quality improvement initiatives

Plan, develop, organize, implement, evaluate, coordinate, and direct PACE program’s infection control program in accordance with current rules, regulations, and guidelines that govern such requirements

Prepare monthly summaries of all participant/personnel infections, corrective action taken, and the results of the corrective action

Lead and facilitate Participant Satisfaction and HOS-M survey process and analyze data

Ensure accurate and timely reporting to CMS, State, and all other Trinity Health PACE reporting requirements

Daily monitoring of HPMS complaints and memorandums for quality and compliance updates. Coordinate any necessary actions per HPMS memorandum guidance

Prepare and submit monthly quality metrics reporting to Trinity Health PACE and participate in Trinity Health PACE initiatives, meetings, and programs as required

Assist staff in establishing process evaluation, including root cause analyses and performance improvement initiatives

Provide oversight of PACE program Quality and Compliance team members, including developing annual performance reviews

Oversee and/or collaborate with HIM, education, and clinical informatics team members

Qualification

Quality Improvement PlanCMS regulatory complianceHealthcare delivery managementData analysisMicrosoft Office SuiteStaff developmentPresentation skillsConflict management

Required

Must possess a comprehensive knowledge of healthcare delivery and management at a level as normally obtained through a bachelor's degree (Masters Preferred) in Health Administration or other closely related field and approximately five (5) years or more of progressively more responsible related work experience that includes the development and implementation of programs for the elderly population, service operations, and staff development

A combination of education and experience may be acceptable

Demonstrate strong business acumen, decision-making skills, manage conflict effectively and adapt to ongoing change

Maintain a customer-focused mindset with organizational agility and work independently with minimal supervision and sound judgment

Foster collaboration and productivity across cross-functional, virtual teams and communicate clearly and effectively in both written and verbal formats

Engage diverse audiences with well-developed presentation skills

Proficient in Microsoft Office Suite; skilled in email and calendaring tools

Exhibit high personal accountability and strategic planning abilities

Position may require 10% travel within the Centers geographic region